• Journal of Chest Surgery
• /
• v.32 no.4
• /
• pp.368-372
• /
• 1999

Background: Although there have been few reports about minimal skin incision for the repair of congenital heart lesions, minimizing an unsightly scar is a particularly important factor in growing children. We have adopted a technique that permits standard full sternotomy, conventional open chest cardiopulmonary bypass, aortic cross-clamping, left atrial vent, and antegrade cardioplegia with minimal surgical scar. Material and Method: With minimal skin incision and full sternotomy, 40 patients with congenital heart disease underwent open heart surgery from April 1997 through September 1997. Defects repaired included 30 ventricular septal defects, 4 atrial septal defects, and 1 sinus Valsalva aneurysm in 35 children(M:F=17: 18), and 3 Atrial septal defects, 1 ventricular septal defect, and 1 partial atrioventricular septal defect in 5 adults(M:F=1:4). Midline skin incision was performed from the second intercostal space to 1 or 2 cm above the xiphoid process. For full sternotomy, we used the ordinary sternal saw in sternal body, and a special saw in manubrium under the skin flap. During sternal retraction, surgical field was obtained by using two retractors in a crossed direction. Result: The proportion of the skin incision length to the sternal length was 63.1${\pm}$3.9%(5.2∼11cm, mean 7.3cm) in children, and 55.0${\pm}$3.5%(10∼13.5cm, mean 12cm) in adults. In every case, the aortic and venous cannulations could be done through the sternal incision without additional femoral cannulation. There was no hospital death, wound infection, skin necrosis, hematoma formation, or bleeding complication. Conclusion: We conclude that minimal skin incision with full sternotomy can be a safe and effective alternative method for the repair of congenital heart diseases in children and adults.

• Journal of Chest Surgery
• /
• v.41 no.1
• /
• pp.1-11
• /
• 2008

Background: The Damus-Kaye-Stansel (DKS) procedure is a proximal MPA-ascending aorta anastomosis used to relieve systemic ventricular outflow tract obstructions (SVOTO) and pulmonary hypertension. The purpose of this study was to review the indications and outcomes of the DKS procedure, including the DKS pathway and semilunar valve function. Material and Method: A retrospective review of 28 patients who underwent a DKS procedure between May 1994 and April 2006 was performed. The median age at operation was 5.3 months ($13\;days{\sim}38.1\;months$) and body weight was 5.0 kg ($2.9{\sim}13.5\;kg$). Preoperative pressure gradients were $25.3{\pm}15.7\;mmHg$ ($10{\sim}60\;mmHg$). Eighteen patients underwent a preliminary pulmonary artery banding as an initial palliation. Preoperative main diagnoses were double outlet right ventricle in 9 patients, double inlet left ventricle with ventriculoarterial discordance in 6,. another functional univentricular heart in 5, Criss-cross heart in 4, complete atrioventricular septal defect in 3, and hypoplastic left heart variant in 1. DKS techniques included end-to-side anastomosis with patch augmentation in 14 patients, classical end-to-side anastomosis in 6, Lamberti method (double-barrel) in 3, and others in 5. The bidirectional cavopulmonary shunt and Fontan procedure were concomitantly performed in 6 and 2 patients, respectively. Result: There were 4 hospital deaths (14.3%), and 3 late deaths (12.5%) with a follow-up duration of $62.7{\pm}38.9$ months ($3.3{\sim}128.1$ months). Kaplan-Meier estimated actuarial survival was $71.9%{\pm}9.3%$ at 10 years. Multivariate analysis showed right ventricle type single ventricle (hazard ratio=13.960, p=0.004) and the DKS procedure as initial operation (hazard ratio=6.767, p=0.042) as significant mortality risk factors. Four patients underwent staged biventricular repair and 13 received Fontan completion. No SVOTO was detected after the procedure by either cardiac catheterization or echocardiography except in one patient. There was no semiulnar valve regurgitation (>Gr II) or semilunar valve-related reoperation, but one patient (3.6%) who underwent classical end-to-side anastomosis needed reoperation for pulmonary artery stenosis caused by compression of the enlarged DKS pathway. The freedom from reoperation for the DKS pathway and semilunar valve was 87.5% at 10 years after operation. Conclusion: The DKS procedure can improve the management of SVOTO, and facilitate the selected patients who are high risk for biventricular repair just after birth to undergo successful staged biventricular repair. Preliminary pulmonary artery banding is a safe and effective procedure that improves the likelihood of successful DKS by decreasing pulmonary vascular resistance. The long-term outcome of the DKS procedure for semilunar valve function, DKS pathway, and relief of SVOTO is satisfactory.

• Journal of the Korean Society of Radiology
• /
• v.14 no.5
• /
• pp.563-575
• /
• 2020

The purpose of this study is to evaluate the activation characteristics that occur in a linear accelerator for container security inspection. In the computer simulation design, first, the targets consisted of a tungsten (Z=74) single material target and a tungsten (Z=74) and copper (Z=29) composite target. Second, the fan beam collimator was composed of a single material of lead (Z=82) and a composite material of tungsten (Z-74) and lead (Z=82) depending on the material. Final, the concrete in the room where the linear accelerator was located contained magnetite type and impurities. In the research method, first, the optical neutron flux was calculated using the MCNP6 code as a F4 Tally for the linear accelerator and structure. Second, the photoneutron flux calculated from the MCNP6 code was applied to FISPACT-II to evaluate the activation product. Final, the decommissioning evaluation was conducted through the specific activity of the activation product. As a result, first, it was the most common in photoneutron targets, followed by a collimator and a concrete 10 cm deep. Second, activation products were produced as by-products of W-181 in tungsten targets and collimator, and Co-60, Ni-63, Cs-134, Eu-152, Eu-154 nuclides in impurity-containing concrete. Final, it was found that the tungsten target satisfies the permissible concentration for self-disposal after 90 days upon decommissioning. These results could be confirmed that the photoneutron yield and degree of activation at 9 MeV energy were insignificant. However, it is thought that W-181 generated from the tungsten target and collimator of the linear accelerator may affect the exposure when disassembled for repair. Therefore, this study presents basic data on the management of activated parts of a linear accelerator for container security inspection. In addition, When decommissioning the linear accelerator for container security inspection, it is expected that it can be used to prove the standard that permissible concentration of self-disposal.

• Journal of Chest Surgery
• /
• v.43 no.6
• /
• pp.675-680
• /
• 2010

Background: The aim of this study was to identify the distinguishing clinicoradiologic findings of traumatic tracheobronchial injury. Material and Method: Between January 2003 and December 2009, six patients who underwent surgical repair for traumatic tracheobronchial injury due to blunt trauma were included in this study. We evaluated the mechanism of the injury, the coexisting injuries, the time until the making diagnosis and treatment, the diagnostic methods, the anatomic location of the injury and the surgical outcomes. Result: The mechanisms of injury were traffic accident and crushing forces. The frequent symptoms were subcutaneous emphysema, dyspnea and pain, and the common radiologic findings were pneumothorax, mediastinal emphysema, rib fracture and lung contusion. Only 2 patients were diagnosed by chest CT and the others were not diagnosed preoperatively. The location of injury was the trachea in 2 patients and the bronchial tree in 4 patients. There was no postoperative mortality or anastomotic leak; however, vocal cord palsy occurred in one patient. The most distinguishing sign was persistent lung collapse even though the chest tube was connected with negative pressure. Conclusion: Although it was not easy to diagnose traumatic tracheobronchial injury without a clinical suspicion, the distinguishing clinical symptoms and CT findings could help to make an early diagnosis without performing bronchoscopy.

• Journal of Chest Surgery
• /
• v.33 no.4
• /
• pp.290-300
• /
• 2000

Background: To evaluate the diagnostic accuracy of EBT(Electron Beam Tomography) in the diagnosis of conotruncal anomaly and to determine whether it can be used as a substitute for cardiac angiography. Material and Method: 20 patients(11M & 9F) with TOF(n=7, pulmonary atresia 2), DORV(n=7), complete TGV(n=4), & corrected TGV(n=2) were included. The age ranged from 7 days to 26 years(median 60 days). We analyzed the sequential chamber localization, the main surgical concenrn in each disease category (PA size, LVED volume and coronary artery pattern for TOF & pulmonary atresia, the LV mass, LVOT obstruction, coronary artery pattern for complete TGV, and type of VSD and TV-PV distance for DORV, etc) and other associated anomalies(e.g., VSD, arch anomalies, tracheal stenosis, etc). Those were compared with the results of echocardiography(n=19), angiography (n=9), and surgery(n=11). The interval between EBT and echocardiography/angiography was within 20/11 days, respectively except for an angiography in a patient with corrected TGV (48 days). Result: EBT correctly diagnosed the basic components of conotruncal anomalies in all subjects, compared to echocardiography, angiography or surgery. These included the presence, type and size of VSD(n=20), pulmonic/LV outflow tract stenosis(n=15/2), relation of great arteries and the pattern of the proximal epicardial coronary arteries(16 out of 20). EBT proved to be accurate in quantitation of the intrapericardial and hilar pulmonary arterial dimension and showed high correlation and no difference compared with echocardiography, angiography, or surgery(p>0.05) except for left pulmonary arterial & ascending arterial dimension by echocardiography. LVED volume in seven TOF(no difference: p>0.05 & high correlation: r=0.996 with echocardiography), and LV mass in 4 complete TGV were obtained. Additionally, EBT enabled the cdiagnosis of subjlottic tracheal stenosis and tracheal bronchus in 1 respectively. Some peripheral PA stenosis were not detected by echocardiography, while echocardiography appeared to be slightly more accurate than EBT in detecing ASD or PDA. Conclusion: EBT can be a non-invasive and accurate modality of for the evaluation of most anatomical alteration including peripheral PS or interruption in patients with conotruncal anomalies. Combined with echocardiography, EBT study provides sufficient information for the palliative or total repair of anomalies.

• Journal of Chest Surgery
• /
• v.43 no.6
• /
• pp.705-709
• /
• 2010

Background: Esophageal injury requires early and proper management. We want to determine the results of various esophageal injuries. Material and Method: We respectively analyzed 22 patients who were managed for esophageal injury between 1999 and 2009. Based on the medical records, we reviewed the causes of injury, the diagnoses, the treatment methods, the complications and the prognosis. Result: The main causes of esophageal injury were a foreign body in 9 cases (41%) and vomiting in 5 cases (23%). We treated the patients with esophageal primary repair in 12 cases (55%), abscess drainage in 4 cases (18%) and conservative management in 6 cases (27%). There was esophageal leakage in 7 cases (32%) and death occurred in 3 cases (14%). Conclusion: For minor esophageal injury, conservative management was sometimes possible to treat the esophagus, yet aggressive and urgent surgical treatment should be applied for cases of major esophageal injury, including mediastinal abscess.

• Journal of the Korea Institute of Building Construction
• /
• v.11 no.6
• /
• pp.587-596
• /
• 2011

Ultra rapid-hardening cement is widely used for latex-modified mortar and concrete as repair and finishing material during urgent work. The purpose of this study is to evaluate the improvements in strength made to SBR cement mortars by the adding of various admixtures and by the use of different curing methods. SBR cement mortar was prepared with various polymer-cement ratios, curing conditions and admixture contents, and tested for flow, flexural and compressive strengths. From the test results, it was determined that the flow of SBR cement mortar increased with an increase in the polymer-cement ratio, and the water reducing ratio also increased. The strength of cement mortar is improved by using SBR emulsion, and is strengthened by adding metakaoline. The strength of SBR cement mortar cured in standard conditions was increased with an increase in the polymer-cement ratio, and attained the maximum strengths at polymer-cement ratios of 15 % and 10 %, respectively. The maximum strengths of SBR cement mortar are about 1.8 and 1.3 times the strengths of plain mortar, respectively. In this study, it is confirmed that the polymer-cement ratio and curing method are important factors for improving the strengths of rapid-hardening SBR cement mortar.

• Korean Journal of Materials Research
• /
• v.24 no.12
• /
• pp.671-676
• /
• 2014

It is known that bones get damaged by accidents and aging. Since the discovery of Bioglass, various kinds of ceramics have been also found to bond to living bone; some of these ceramics are already being clinically used as bone-repairing materials. In the present study, antibacterial calcium silicate gel ($Ag-30CaO{\cdot}70SiO_2$ gel) was prepared by sol-gel method in order to control the microstructure, which is related to the dissolution rate and induction period of apatite formation in body environment. In addition, biological $Ag-30CaO{\cdot}70SiO_2$ is tested. This was done to impart antimicrobial activity to the $30CaO{\cdot}70SiO_2$. Ag ion was added during sol-gel synthesis to replace the $H_2O$ added during the making of the $30CaO{\cdot}70SiO_2$ gel, which has silver solutions of various concentration. After the sol-gel process, 1N-$HNO_3$ solution was used to wash the gel when synthesizing the gel, in order to maintain the porous structure and remove PEG, water soluble polymers. Then, the apatite forming ability of the sol-gel derived CaO-$SiO_2$ gels was investigated using simulated body fluid (SBF), which had almost the same ion concentration as that of human blood plasma. The gels were analyzed by FT-IR spectroscopy, SEM observation, XRD, and fluorescent microscopy. The apatite was successfully created even after washing the gel; apatite is present in an amorphous state, and was found to affect the concentration of the Ag ion in cells in MC3T3 live & dead assay results. From these results, it is suggested that a good material that can be used to repair defects of nature bone is $Ag-30CaO{\cdot}70SiO_2$ gel.

• Proceedings of the KWS Conference
• /
• 2009.11a
• /
• pp.100-100
• /
• 2009

This paper is concerned with numerical analyses of residual stresses in welds and material's susceptibility to stress corrosion cracking (SCC) for the primary piping system in nuclear power plants: Both the dissimilar metal weld (DMW) for stainless steel to low alloy steel joints and the similar metal weld (SMW) for forged stainless steel to cast stainless steel joints are considered. Thermal elasto-plastic analyses using the finite element method (FEM) are performed to predict residual stresses generated in fabrication welding and its related processes for both the DMW and SMW, including effects of quenching for cast stainless steel piping, machining of the DMW root, and grinding of the SMW root. As a result, the effect of quenching should be included in the evaluation of residual stresses in the SMW for the cast stainless steel piping. It is deemed that residual stresses in both the DMW and SMW would not affect the SCC susceptibility of the welds providing that the welding processes are completed without any weld repair on the inside wall of the joint. However, the grinding process if performed on the safe-end to piping weld, would produce a high level of residual stresses in the inner surface region and thus a stress improvement process (e.g. buffing) should be considered to reduce susceptibilities to SCC.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.19 no.2
• /
• pp.632-638
• /
• 2018

Recently, damage to waterside structures, such as bridges or retaining walls, is increasing due to typhoons, flooding, aging, etc. In such cases, the damage is not limited to the structures themselves, but can include effects on a wider scale, such as the suspension of and restriction of access to the facilities, human injury, economic loss, etc. To preclude such damage, recovery methods suitable for the particular field circumstances should be applied when damage occurs. By enforcing prompt repairs, the material and human damage and losses that can occur can be minimized. Since the impact of losses caused by damage and disaster increases with the elapse of time, emergency recovery is even more important. In the emergency recovery process, appropriate repair and reinforcement is crucial. In the present study, the derivation scenarios of the emergency recovery method were applied to some field recovery cases, and their applicability was verified by comparison with the recovery methods actually used. It is expected that the results of this study will be useful for practical application, by suggesting more appropriate recovery methods.